Sex Differences in Recovery Across Multiple Domains Among Older Adults With Hip Fracture

Association Between Prehip Fracture Antidepressant Use and Posthip Fracture Length of Hospital Stay in Medicare Beneficiaries and Assessing Sex Differences

OBJECTIVE

Antidepressants are the first-line treatment for depression among older adults. While antidepressants are associated with increased risk of falls and fractures in older adults, their effect on outcomes after fall-related injuries such as hip fracture, and whether these effects differ by sex, is unknown. Thus, the purpose of this study was to examine the association between prefracture antidepressant use and hospital length of stay (LOS) among hip fracture survivors, and related sex differences.

METHODS

Participants included 17,936 community-dwelling Medicare fee-for-service beneficiaries with depression and hospitalization claim for hip fracture surgery between 2010 and 2017. Ordinal logistic regression estimated the association between prefracture antidepressant use and hospital LOS in days, categorized into three groups (1-4, 5-8, and 8+ days) during the 30-day postfracture period, adjusting for demographic, medical, facility, and geographic factors. A sex-by-antidepressant use interaction term was included to examine effect heterogeneity by sex.

RESULTS

Prefracture antidepressant users (47%, n = 8,350) were more likely to be younger, White females. The adjusted ordinal logistic regression showed beneficiaries who used antidepressants had 8% higher odds of being in a shorter hospital LOS category compared to non-users (OR = 1.08; 95% CI = 1.02, 1.14; p=0.01). The sex-by-antidepressant use interaction was not statistically significant (p=0.92).

CONCLUSIONS

Among older adults with depression who subsequently experienced a hip fracture, antidepressant use of >30 days in the 6 months prior to fracture was associated with a shorter hospital LOS. These findings indicate that use of antidepressants does not prolong early recovery from hip fracture and may be protective.

Sex-specific associations of vitamin D and bone biomarkers with bone density and physical function during recovery from hip fracture: the Baltimore Hip Studies

Less is known about recovery from hip fracture in men. We found differences in 25-hydroxyvitamin D and bone biomarkers between men and women during the year after hip fracture, underscoring the importance of vitamin D assessment in older men and pharmaceutical treatment to reduce bone resorption after hip fracture.

PURPOSE

Less is known about recovery from hip fracture in men compared to women. We examined differences between men and women in 25-hydroxyvitamin D (25OHD) and bone turnover markers, and associations with bone mineral density (BMD) and physical function, during the year after a hip fracture.

METHODS

Community-dwelling, ambulatory adults aged 65 years and over (157 men and 154 women) enrolled in the Baltimore Hip Studies 7th cohort were included. We analyzed 25OHD, C-terminal telopeptide (β-CTX-I), procollagen type I N-terminal propeptide (PINP), PTH, and femoral neck BMD at baseline, 2, 6, and 12 months after hip fracture, and short physical performance battery (SPPB) at 2, 6, and 12 months.

RESULTS

During admission for hip fracture, median 25OHD levels were 15.2 ng/mL (IQR 10.0) in men compared with 23.9 ng/mL (IQR 13.4) in women and remained lower in men at 2, 6, and 12 months (all p < 0.001). β-CTX-I was higher in men on admission, and at 2 and 6 months (all p < 0.05), and PINP was higher in men at 6 months (p = 0.04), with no significant differences between men and women in PTH. Higher 25OHD and PINP concentrations in women only and lower β-CTX-I and PTH concentrations in both sexes were associated with greater BMD. Higher 25OHD concentrations were associated with higher SPPB scores in both sexes.

CONCLUSIONS

These findings underscore the importance of vitamin D assessment in older men and missed opportunities in both sexes for vitamin D supplementation and pharmaceutical treatment to reduce bone resorption after hip fracture.

Related factors of postoperative half-year care utilization for health status and recovery in older adults with hip fracture: A retrospective study of Osaka National Health Insurance Data

AIM

The aim of this study was to investigate the relationship between preoperative patient factors and postoperative half-year health care utilization reflecting recovery, common complications, comorbidities, and significant health concerns, identifying strong risk and protective factors.

METHODS

This retrospective cohort study utilized linear, quantile, and ordinal regressions to analyze Osaka National Health Insurance data from 26 606 elderly patients who underwent hip fracture surgery between 2012 and 2018.

RESULTS

The key factors associated with multiple postoperative care utilizations (P < 0.001) included: 1 Compared with men, women were strongly negatively correlated with postoperative length of stay (LOS) at q90, diabetes prescriptions or drip injections, while showing strong positive associations with postoperative antihypertensive, antiosteoporosis, and antidementia prescriptions. 2 Age has a strong negative correlation with antiosteoporosis or diabetes prescriptions but strongly positive associations with indwelling urinary catheters or drip injections. 3 The preoperative 1-year LOS correlated positively with the postoperative LOS or indwelling urinary catheters, and the strongest associations were observed at q25 with the postoperative LOS. It was significantly and negatively associated with antihypertensive or antidementia prescriptions. 4 Many preoperative care utilizations were positive factors, and some were strong factors at q25 of the LOS.

CONCLUSIONS

Nuanced relationships between the female sex; preoperative LOS; antidementia, antiosteoporosis, antihypertensive and constipation prescriptions; indwelling catheters, and postoperative LOS were elucidated. These are key risks during shorter postoperative LOS, while male subgroups are at a higher risk during longer LOS duration. Patients with extended preoperative diabetes prescriptions or drip injections are at high risk of multiple postoperative care. Geriatr Gerontol Int 2025; 25: 190-205.

Patients Residing in Areas of Increased Social Vulnerability Are at an Increased Risk for Prolonged Length of Stay and Mortality After Hip Fracture Surgery

INTRODUCTION

Patients undergoing hip fracture surgery face notable risks of postoperative morbidity and mortality, and racial and socioeconomic disparities in outcomes exist. This study examined the effect of social vulnerability on outcomes after hip fracture surgery using the CDC's Social Vulnerability Index (SVI).

METHODS

A retrospective study of 464 patients undergoing hip fracture surgery at a single institution from July 2020 to June 2023 was conducted. Demographics, comorbidities, time to surgery, length of stay (LOS), and postoperative outcomes were compared between patients with low versus high social vulnerability. SVI was calculated based on patient's zip code of residence. The 50th percentile of national SVI scores was used to divide patients into low and high vulnerability groups. Univariate and multivariable analyses were done to compare patient characteristics and outcomes between the groups. The primary outcome of interest was 1-year postoperative mortality.

RESULTS

No notable differences were observed in demographics, comorbidities, or procedure performed between the groups. Patients with increased social vulnerability had a higher rate of mortality within 1 year (low vulnerability: 12.2 vs. high vulnerability: 24.0%, P = 0.005) and a shorter time to mortality (340.7 vs. 138.9 days, P < 0.001). Patients with higher social vulnerability had longer LOS (β = 1.12, 95% CI: 0.35-1.88, P = 0.004), were 2.37 times more likely to experience mortality within 1 year (OR = 2.37, 95% CI: 1.30-4.27, P = 0.004), and 1.75 times more likely to experience mortality at any time (OR = 1.75, 95% CI: 1.01-2.99, P = 0.045).

CONCLUSION

Patients residing in areas of increased social vulnerability were more likely to experience a longer LOS, and more likely to die within 1 year, or at any time after undergoing hip fracture surgery, when compared with those living less socially vulnerable regions. These findings highlight the need for interventions aimed at addressing social factors within hip fracture care pathways to mitigate socioeconomic disparities in patient outcomes.

Predictors of Hospital Readmission, Institutionalization, and Mortality in Geriatric Rehabilitation Following Hospitalization According to Admission Reason

BACKGROUND AND PURPOSE

Older adults following an inpatient geriatric rehabilitation (GR) program commonly experience adverse health outcomes such as hospital readmission, institutionalization, and mortality. Although several studies have explored factors related to these outcomes, the influence of admission reason on the predictive factors of adverse health outcomes in the rehabilitation process remains unclear. Therefore, this study aimed to identify predictive factors for adverse health outcomes in inpatients attending GR according to their admission reason.

METHODS

This retrospective study included patients with orthogeriatric (OG) conditions and patients with hospital-associated deconditioning (HAD) admitted to GR after an acute hospitalization between 2016 and 2020. Patients were evaluated by a comprehensive geriatric assessment at admission, including sociodemographic data, social resources, clinical data, cognitive, functional and nutritional status, and physical performance measurements. Adverse health outcomes were collected (hospital readmission, institutionalization, and mortality). Univariate analyses and multivariate backward binary logistic regressions were used to determine predictive factors.

RESULTS AND DISCUSSION

In this study, 290 patients were admitted for OG conditions, and 122 patients were admitted due to HAD. In patients with OG conditions, lower Mini-Mental State Examination (MMSE) predicted institutionalization and mortality. Lower Mini Nutritional Assessment-Short Form predicted institutionalization, whereas lower Barthel Index and lower Tinetti-Performance-Oriented Mobility Assessment scores were associated with higher mortality. In patients with HAD, higher age-adjusted comorbidity index predicted hospital readmission and mortality, and lower Short Physical Performance Battery scores predicted institutionalization and mortality. Finally, lower MMSE scores, worse values in Older Americans Resources and Services Scale and male gender were associated with a higher risk of institutionalization.

CONCLUSIONS

Predictive factors for hospital readmission, institutionalization, and mortality in patients with OG conditions and HAD during GR were different. Some of those predictors, such as nutritional status and physical performance, are modifiable. Understanding predictive factors for adverse outcomes, and how these factors differ by admission diagnosis, improves our ability to identify patients most at risk. Early identification of these patients could assist with prevention efforts and lead to a reduction of negative outcomes.

Association between pre-hip fracture depression and days at home after fracture and assessing sex differences

BACKGROUND

Hip fracture and depression are important public health issues among older adults, but how pre-fracture depression impacts recovery after hip fracture is unknown, especially among males who often experience greater depression severity. Days at home (DAH), or the days spent outside a hospital or healthcare facility, is a novel, patient-centered outcome that can capture meaningful aspects of fracture recovery. How pre-fracture depression impacts DAH after fracture, and related sex differences, remains unclear.

METHODS

Participants included 63,618 Medicare fee-for-service beneficiaries aged 65+ years, with a hospitalization claim for hip fracture surgery between 2010 and 2017. The primary exposure was a diagnosis of depression at hospital admission, and the primary outcome was total DAH over 12 months post-discharge. Longitudinal associations between pre-fracture depression and the count of DAH among beneficiaries were estimated using Poisson regression models after adjustment for covariates; sex-by-depression interactions were also assessed. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) reflecting relative differences were estimated from these models.

RESULTS

Overall, beneficiaries with depression were younger, White females, and spent 11 fewer average DAH compared to counterparts without depression when demographic factors (age and sex) (IRR = 0.91; 95% CI = 0.90, 0.92; p < 0.0001) and social determinants of health (race, Medicaid dual eligibility, and poverty) were adjusted for (IRR = 0.92; 95% CI = 0.91, 0.93; p < 0.0001), but this association attenuated after adjusting for medical complexities (IRR = 0.99; 95% CI = 0.98, 1.01; p = 0.41) and facility and geographical factors (IRR = 1.0037; 95% CI = 0.99, 1.02; p = 0.66). There was no evidence of effect modification by sex.

CONCLUSIONS

The comorbidity burden of preexisting depression may impact DAH among both male and female Medicare beneficiaries with hip fracture. Results suggest a holistic health approach and secondary prevention of depressive symptoms after hip fracture.

The Impact of Frailty and Gender Differences on Hospitalization and Complications in Proximal Femoral Pathological Fractures: A Cross-Sectional Study

BACKGROUND

Frailty associated with aging increases the risk of falls, disability, and death. The aim of this study is to explore gender-related disparities in the survival outcomes of pathological femoral fractures in older frail patients, while analyzing potential specific prognostic factors.

METHODS

This study is a retrospective observational analysis conducted at a single medical center. It enrolled all patients aged 65 and above who were admitted to our emergency department between 2016 and 2020 with a diagnosis of pathological femur fracture requiring surgical intervention. The primary study endpoint was evaluating gender-related differences in survival outcomes. The secondary endpoint involves investigating gender-specific prognostic factors through the analysis of clinical and laboratory parameters.

RESULTS

The average Charlson Comorbidity Index (CCI) was slightly lower in men, but the difference was not statistically significant (p = 0.53). The Clinical Frailty Scale (CFS) showed similar results, with men and women 5.23 (SD 1.46), also not significant (p = 0.83). An evaluation comparing patients aged 75 years or younger to those older than 75 years found significant differences in health metrics. The average CCI was higher in the over 75 group compared to the under 75 group, with a p-value of 0.001. Similarly, the CFS average was also greater in the over 75 group than in the under 75 group, with a p-value of 0.0001. Complications were more frequent in patients over 75 and those with lower educational qualifications. The evaluation analyzed cardiac patients compared to a control group, revealing that the average age of cardiac patients was 75.22 years, while the control group was younger at 73.98 years (p = 0.5119). The CCI for cardiac patients averaged 6.53, significantly higher than 4.43 for non-cardiac patients (p = 0.0003).

CONCLUSION

Frailty assessment is therefore essential in patients with pathological fracture of the proximal femur and is an important predictor of both gender differences and hospital complications. Enhancing gender analysis in this field is crucial to gather more robust evidence and deeper comprehension of potential sex- and gender-based disparities.

Evaluating Short-Term Patient-Reported Outcome Measures Following Total Hip and Knee Replacement: A Comprehensive Review

Total hip replacement (THR) and total knee replacement (TKR) are widely performed surgical procedures to alleviate pain and improve function in patients with joint-related diseases. Short-term patient-reported outcome measures (PROMs) have become a key metric in assessing the success of these surgeries from the patient's perspective, focusing on early recovery, pain management, mobility, and quality of life. This comprehensive review evaluates the significance of short-term PROMs following THR and TKR, highlighting commonly used tools such as the Oxford Hip Score (OHS), Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and short-form health survey (SF-36). The analysis explores the impact of various factors, such as age, preoperative health status, and surgical technique, on short-term outcomes. Findings from recent studies indicate that while patients generally report improvements in physical function and pain relief within the first six months post-surgery, individual outcomes can vary significantly. Factors like early rehabilitation, mental health, and the presence of postoperative complications can influence the trajectory of recovery and satisfaction levels. Moreover, the review addresses the limitations of current PROMs, including variability in reporting and sensitivity to different patient populations. This review emphasizes the need for more personalized and standardized approaches to PROM assessment to better capture patient experiences and optimize postoperative care. Future research should focus on integrating PROMs with long-term follow-up data and digital health tools to track real-time patient progress, thus enhancing the overall quality of care for THR and TKR patients. Short-term PROMs play a vital role in understanding patient outcomes and guiding clinical practice for joint replacement surgeries.

Sex differences in mobility recovery after hip fracture: a time series analysis

Introduction

Sex differences are commonly reported for hip fracture incidence rates and recovery. Current knowledge about mobility recovery after hip fracture involves clinical assessments of physical capacity or patient-reported outcomes. Information on mobility performance during daily life is missing but relevant to evaluate patients' recovery. Hence, it remains unclear whether sex differences exist in the longitudinal progression of mobility performance in hip fracture patients. To investigate this, we pooled data from four studies in Germany and Norway.

Methods

In all studies, real-world mobility was assessed continuously over 1 to 7 days using a sensor fixed to the unaffected frontal thigh. All studies assessed mobility at different time points that were allocated to three distinct phases: Acute and post-acute phase (week 1-6), extended recovery (7-26), and long-term recovery (27-52). Sex-specific continuous trajectories of the median (50th percentile) as well as the 1st (25th percentile) and 3rd quartile (75th percentile) were estimated using quantile regression models with splines for daily walking and standing duration; number of sit-to-stand-to-walk transfers and walking bouts; mean walking bout duration; maximum number of steps per walking bout.

Results

There were 5,900 valid observation days from n = 717 participants (mean age = 83.4 years, SD 6.1). The majority was female (75.3%), with similar sex distribution across all studies. Demographics of both sexes were comparable, but a higher percentage of women was living alone (69.0% compared to 40.9% in men) and had experienced an indoor fall leading to the fracture (74.3% compared to 67.4% in men). There were clear sex differences in mobility recovery. Women improved their mobility faster than men, but men showed larger increases later in the year after surgery. At the end of the first year, both sexes reached comparable levels in almost all mobility parameters.

Conclusion

We identified varying aspects of mobility recovery between men and women, i.e., timely development of mobility recovery shows different patterns. Our findings support the consideration of sex differences in planning and implementing rehabilitation measures for hip fracture patients and highlight the need to provide adapted support at different time points. The underlying mechanisms of these sex differences need further investigation.

Exploring Factors Associated With Resilience and Physical Activity in Older Men and Women Post-Hip Fracture

This study aimed to test a model of factors associated with resilience and physical activity post-hip fracture and compare model fit between men and women. We used data from the seventh Baltimore Hip Study that included 339 participants. Model testing indicated that health status (men: β = .237, p = .002; women: β = .265, p = <.001), depression (men: β = -.245, p = .001; women: β = -.241, p = <.001), and optimism (men: β = .320, p = <.001; women: β = .282, p = <.001) were associated with resilience in men and women, but resilience was only associated with physical activity in men (β = .203, p = .038) and not in women. Social interaction was related to physical activity only among women (β = .206, p = .044). This study provides support for the relationship between resilience and physical activity at least among men.

Longitudinal characteristics of physical frailty and its components in men and women post hip fracture

BACKGROUND

Frailty is an important geriatric syndrome predicting adverse health outcomes in older adults. However, the longitudinal characteristics of frailty components in post-hip fracture patients are less understood. Adopting the Fried frailty definition, we examined the longitudinal trends and sex trajectory differences in frailty and its components over 1 year post-fracture.

METHODS

Three hundred and twenty-seven hip fracture patients (162 men and 165 women with mean age 80.1 and 81.5) from Baltimore Hip Studies 7th cohort with measurements at 22 days after admission, and months 2, 6, and 12 post-fracture were analyzed. Frailty components included: grip strength, gait speed, weight, total energy expenditure, and exhaustion. Longitudinal analysis used mixed effect models.

RESULTS

At baseline, men were sicker with worse cognitive status, and had higher weight and grip strength, but lower total energy expenditure than women (p < 0.001). The prevalence of frailty was 31.5%, 30.2%, and 28.2% at months 2, 6, and 12 respectively, showing no longitudinal trends or sex differences. However, its components showed substantial recovery trends over the post-fracture year after confounding adjustments, including increasing gait speed, reducing risk of exhaustion, and stabilized weight loss and energy expenditure over time. Particularly, while men's grip strength tended to remain stable over first year post surgery within patients, women's grip strength reduced significantly over time within patients. On average over time within patients, women were more active with higher energy expenditures but lower grip strength and weight than men.

CONCLUSION

Significant recovery trends and sex differences were observed in frailty components during first year post-fracture. Overall frailty status did not show those trends over months 2-12 since a summary measure might obscure changes in components. Therefore, frailty components provided important multi-dimensional information on the complex recovery process of patients, indicating targets for intervention beyond the global binary measure of frailty.

Multicomponent Home-based Physical Therapy Versus Usual Care for Recovery After Hip Fracture

OBJECTIVE

To quantify the effect of 2 home-based 16-week multi-component physical therapy interventions on functional recovery compared to usual care after hip fracture.

DESIGN

Cross-study comparison using participants from the Community Ambulation Project (CAP; a randomized controlled trial) were compared to the Baltimore Hip Studies-seventh cohort (BHS-7; an observational cohort study) at 3 different time points (CAP: 15, 31, 55 weeks; BHS-7: 8, 26, and 52 weeks).

SETTING

General community PARTICIPANTS: Combined convenience sample of hip-fracture patients 8-26 weeks post admission from a prospective cohort study and randomized controlled trial. (N=549) INTERVENTIONS: CAP participants were randomized to one of 2 interventions (PUSH: specific multi-component intervention; PULSE: non-specific multi-component intervention) after standard rehabilitation; BHS-7 participants received usual care.

MAIN OUTCOME MEASURES

Mean function (as measured by Short Physical Performance Battery (SPPB) and gait speed) was estimated in each cohort as quadratic functions of time using data from 3 post-fracture assessments in both studies (CAP: 15, 31, 55 weeks; BHS-7: 8, 26, and 52 weeks).

RESULTS

The harmonized samples included 101 PUSH, 100 PULSE, and 128 BHS-7 participants that had different demographic and clinical characteristics. Mean baseline SPPB scores (meters per second) were PUSH: 5.5 (SD=2.2), PULSE: 5.5 (SD=2.4), and BHS-7: 4.6 (SD=2.5); and mean gait speeds were 0.60 m/s (SD=0.20) for PUSH, 0.59 m/s (SD=0.17) for PULSE, and 0.46 m/s SD=(0.21) for BHS-7, respectively. Estimated between-group differences for SPPB improvement from 75 days to 1-year post admission were 0.7 (P=.04) in PUSH vs BHS-7; and 0.9 (P=.01) in PULSE vs BHS-7. Mean differences in change in gait speed were 0.08 (P=.002) for PUSH vs BHS-7; and 0.06 (P=.02) PULSE vs BHS-7 (P=.02).

CONCLUSIONS

Findings from this cross-study comparison that combined participants from 2 separate studies, with different designs and samples, suggest that home-based multi-component physical therapy programs were associated with greater functional improvement after hip fracture compared to usual care.

Associations between living alone, social interactions, and physical performance differ by sex: Results from the Baltimore Hip Studies

BACKGROUND

There is mixed evidence on whether living arrangements and social interactions are associated with poorer health outcomes after hip fracture repair. Distinct social profiles among male and female older adults may explain some of the differences. However, prior studies did not evaluate these differences by sex. This article aims to assess if the associations between living alone, social interaction, and physical performance differ by sex among hip fracture survivors.

METHODS

This prospective cohort study is part of the Baltimore Hip Studies seventh cohort, with 168 male and 171 female hip fracture patients assessed at baseline (≤22 days after hospitalization) and at 2, 6, and 12 months post admission. Living arrangements and interaction with children or siblings and others in the past 2 weeks were collected at all visits. Physical performance was measured in the follow-up visits with the Short Physical Performance Battery (SPPB). Linear mixed models tested associations of living alone and social interaction with SPPB over time adjusted for age, education, comorbidities, physical functioning pre-fracture, cognitive function, self-rated health, and time.

RESULTS

For men only, living alone was associated with worse performance (0.7 points lower SPPB scores, p = 0.05). Higher social interaction was associated with 0.8 and 1.2 point higher SPPB scores for men and women, respectively (p < 0.05). Visiting with friends was significantly associated with better function among males, while visiting with children or siblings was associated with worse SPPB among females.

CONCLUSIONS

Living arrangements and types of social interaction are differentially associated with physical function for older men and women. Screening for social isolation/integration and including interventions that promote social interaction and participation should be considered in healthcare programs for hip fracture survivors.

Predictors of mobility status one year post hip fracture among community-dwelling older adults prior to fracture: A prospective cohort study

BACKGROUND

Orthopedists and other clinicians assess recovery potential of hip fracture patients at 2 months post-fracture for care planning. It is unclear if examining physical performance (e.g., balance, gait speed, chair stand) during this follow-up visit can identify individuals at a risk of poor functional recovery, especially mobility, beyond available information from medical records and self-report.

METHODS

Data came from 162 patients with hip fracture enrolled in the Baltimore Hip Studies-7th cohort. Predictors of mobility status (ability to walk 1 block at 12 months post-fracture) were the Short Physical Performance Battery (SPPB) comprising balance, walking and chair rise tasks at 2 months; baseline medical chart information (sex, age, American Society of Anesthesiologist physical status rating, type of fracture and surgery, and comorbidities); and self-reported information about the physical function (ability to walk 10 feet and 1 block at pre-fracture and at 2 months post-fracture). Prediction models of 12-month mobility status were built using two methods: (1) logistic regression with least absolute shrinkage and selection operator (LASSO) regularization, and (2) classification and regression trees (CART). Area under ROC curves (AUROC) assessed discrimination.

RESULTS

The participants had a median age of 82 years, and 49.3% (n = 80) were men. Two-month SPPB and gait speed were selected as predictors of 12-month mobility by both methods. Compared with an analytic model with medical chart and self-reported information, the model that additionally included physical performance measures had significantly better discrimination for 12-month mobility (AUROC 0.82 vs. 0.88, p = 0.004).

CONCLUSION

Assessing SPPB and gait speed at 2 months after a hip fracture in addition to information from medical records and self-report significantly improves prediction of 12-month mobility. This finding has important implications in providing tailored clinical care to patients at a greater risk of being functionally dependent who would not otherwise be identified using regularly measured clinical markers.

Health-related quality of life of men with primary osteoporosis and its changes after bisphosphonates treatment

INTRODUCTION

Osteoporosis leads to more serious consequences in men than in women, but less is known about its impacts on health-related quality of life (HRQoL) of men, and whether the anti-osteoporosis treatment can improve HRQoL of men with osteopenia/osteoprosis.

METHODS

We enrolled men with primary osteoporosis and age-matched healthy controls. We collected medical history, serum levels of carboxyl-terminal type I collagen telopeptide, procollagen type I propeptides, and bone mineral density of patients. All patients and controls completed the short-form 36 (SF-36) questionnaires. Changes in HRQoL of osteopenia/osteoporosis men were prospectively evaluated after alendronate or zoledronic acid treatment.

RESULTS

A total of 100 men with primary osteoporosis or osteopenia and 100 healthy men were included. The patients were divided into three subgroups: osteopenia (n = 35), osteoporosis (n = 39) and severe osteoporosis (n = 26). Men with osteoporosis or severe osteoporosis had impaired HRQoL in domains of physical health compared to healthy controls. HRQoL scores in physical health related domains of patients with severe osteoporosis were significantly lower compared to healthy controls, and were the poorest among the three subgroups of patients. Fragility fracture history was correlated with lower SF-36 scores about physical health. In 34 men with newly diagnosed osteoporosis receiving bisphosphonates treatment, HRQoL scores were significantly improved in domains of physical health after treatments.

CONCLUSIONS

The HRQoL is significantly impaired in men with osteoporosis, and the more severe the osteoporosis, the poorer the HRQoL. Fragility fracture is an important influencing factor of deteriorated HRQoL. Bisphosphonates treatment is beneficial to improve HRQoL of osteopenia/osteoporosis men.

Sex Differences in the Burden of Hip Fractures on Functional Status in Older Age

Background: Hip fractures can dramatically impact the health and self-sufficiency of older people. We investigated the influence of pre-fracture functional status on functional decline and mortality after hip fracture, and possible sex differences in this regard. Materials and Methods: The sample comprised 288 older patients hospitalized with hip fracture in an Orthogeriatric Unit. Data on perioperative management and multidimensional evaluation were collected. After 15 months, we obtained information on housing arrangements, new falls, walking level, and self-sufficiency (Barthel Index [BI]) through outpatient visits or phone interviews. Data on re-hospitalizations and deaths were obtained from hospital records. Results: The sample median age was 87 years, and 75% were women. The median pre-fracture BI was 75 (interquartile range [IQR]: 50, 100), and at follow-up it decreased by a median of 20 (IQR: 40, -5) points. Sex differences emerged among those with the highest pre-fracture functional status (BI ≥85), with women showing lower BI loss than men (-15 [IQR: -40, 0] vs. -30 [IQR: -80, -15], respectively; p = 0.04). A pre-fracture BI ≥85 (vs. <85) was associated with a 41% lower mortality rate (95% confidence interval [95% CI]: 0.21-0.79), especially in women (hazard ratios = 0.28, 95% CI: 0.11-0.69). Moreover, male sex was an independent risk factor for functional loss after a hip fracture (odds ratio = 2.52, 95% CI: 1.09-5.80). Conclusions: Older men may have a worse functional prognosis than women after a hip fracture. This difference seemed to be exacerbated in cases of high pre-fracture functional performance, suggesting that females have a greater functional reserve, namely better adaptation and recovery strategies to deal with the fracture. Clinical Trial Registration: Registration code: NCT02687698.

Prognostic Factors for Mortality, Activity of Daily Living, and Quality of Life in Taiwanese Older Patients within 1 Year Following Hip Fracture Surgery

Background. Hip fractures among older adults are a major public health concern worldwide. This study investigated the potential clinical factors that predict postoperative 1-year activities of daily living (ADL), quality of life (QoL), and mortality in Taiwanese older adults following hip fracture. Methods. This is a prospective cohort study enrolling older adults (≥60 years) who had undergone hip fracture surgery in a single medical center. The comprehensive clinical history of each patient was examined. QoL, ADL, and mortality events were recorded consecutively at 3, 6, and 12 months after operation. The multiple logistic regression model and the generalized estimating equation (GEE) were adopted to identify contributing factors for mortality and postoperative ADL and QoL prognosis, respectively. Results. Among 377 participants with hip fracture, 48 died within 1 year of the index operation. ADL and QoL considerably decreased at 3 months following hip surgery. Old age, high Charlson Comorbidity Index, and American Society of Anesthesiologists grading were crucial predictors for mortality at the 1-year follow-up. The generalized estimating equation analysis indicated that the length of postoperative follow-up time, serum albumin level, patient cognitive status, and handgrip strength were considerably associated with QoL and ADL recovery prognosis in the Taiwanese older adults following hip fracture. Conclusions. Hip fractures have long-lasting effects on the older adults. Our data imply several prognosis predicting parameters that may assist clinicians in accounting for an individual’s personalized risks in order to improve functional outcomes and reduce mortality.